The US Preventive Services Task Force Should Consider A Broader Evidence Base In Updating Its Diabetes Screening Guidelines

Lewin Contact: Cliff Goodman

The Lewin Group published a new report in the January 2012 thematic issue of Health Affairs on Confronting The Growing Diabetes Crisis. The article, "The US Preventive Services Task Force Should Consider A Broader Evidence Base In Updating Its Diabetes Screening Guidelines" discusses the merits of broadening the types of items considered in diabetes screening in order to facilitate the prevention and early treatment of diabetes. Read more at http://content.healthaffairs.org/content/31/1/35

This article on CER that targets Child and Adolescent Health was published in a special CER-focused issue by Health Affairs. The article details how CER needs to be targeted, designed, conducted, and reported in ways that are responsive to the unique circumstances of children and adolescents

The contributions of clinical laboratory screening and diagnostic tests to health care quality and outcomes are substantial. These contributions were described in an earlier report from The Lewin Group, The Value of Diagnostics Innovation, Adoption, and Diffusion in Health Care (2005). This report updates key elements of that study, providing a current overview of the important role of laboratory screening and diagnostic tests in our health care system, today’s means of assessing value, and four case studies documenting value of specific tests to patient care.

This report, commissioned by the Centers for Disease Control and Prevention provides a detailed overview of the key factors affecting the laboratory medicine sector. It is intended that the report serve as a point of reference for measuring and improving quality in the future as well as for policy guidance to professional organizations, government agencies, and others who provide, use, regulate, and pay for laboratory services.

This report, prepared for the Advanced Medical Technology Association (AdvaMed), presents estimates of the economic contributions of the Medical Technology Industry (MTI) to each of the 50 states and the District of Columbia. This includes 2006 estimates for each state of MTI employment, payrolls, and sales/shipments and of the multiplier economic effects on these same measures.

American Association of Clinical Endocrinologists, International Society for Clinical Densitometry, The Endocrine Society, American College of Rheumatology

Osteoporosis is a disease that is characterized by low bone mass and a deterioration of bone structure that results in bone fragility and an increased risk of fracture. The disease affects 10 million older Americans and is associated with significant mortality and morbidity. An additional 34 million individuals have osteopenia (low bone mass) and are at increased risk of fracture at some time in their lives. Osteoporosis-related fractures represent a serious illness burden and are a major cause of disability among Medicare beneficiaries. Dual-energy X-ray absorptiometry (DXA) is the “gold standard” for diagnosing osteoporosis, using World Health Organization criteria. Amid recent changes in Medicare reimbursement methodology, providers had become concerned that payment for DXA and vertebral fracture assessment (VFA) was below operating costs. However, a systematic study of the cost to perform a DXA procedure had not been conducted. The American Association of Clinical Endocrinologists, the International Society for Clinical Densitometry, The Endocrine Society and the American College of Rheumatology commissioned The Lewin Group to survey office-based providers of DXA, in order to develop estimates of the costs associated with providing DXA services to Medicare beneficiaries. This study should assist policymakers and others to determine whether the current Medicare reimbursement for DXA approximates real world operating costs.

DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)

Lewin contact: Clifford Goodman

The concept of personalized health care (PHC) has attracted considerable scientific, medical, commercial and policy interest for its potential to sharpen the focus of health care and improve its effectiveness and efficiency. As part of a broader vision of advancing and leveraging medical research to improve and transform health care in the US, the Secretary of the US Department of Health and Human Services (DHHS) has identified personalized health care as one of the Department’s top 10 priorities. The Office of the Assistant Secretary for Planning and Evaluation commissioned The Lewin Group to convene a PHC Expert Panel to provide input to the Office of the Secretary, DHHS, toward realizing the integration of PHC into clinical and public health practice. During the meeting the panel considered and discussed five main issues pertaining to the integration of PHC into clinical and public health practice: Demonstrating clinical validity and utility of PHC; Demonstrating value/cost-effectiveness of PHC Identifying the role of PHC in reducing health disparities Educating and engaging providers and patients about PHC; and Using databases to build evidence and inform decisions in PHC. The report summarizes key observations that emerged from the Expert Panel’s discussion of these five main issues.

DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)

Lewin contact: Clifford Goodman

The Office of the Assistant Secretary for Planning and Evaluation commissioned The Lewin Group to determine how and to what extent cost-effectiveness (CE) considerations are incorporated in the approval and adoption of new health technologies and the implications of not incorporating such considerations. This report examines the use of CE and other cost-health tradeoff evidence by federal and nonfederal health stakeholders, paying particular attention to the scope of authority, range and/or circumstances of use, and responsibilities for regulating CE and other economic information by the Food and Drug Administration. The role of economic evidence in decision-making also is explored in case studies of four contemporary health technologies: nucleic acid testing, Relenza (zanamivir), drug-eluting stents, and implantable cardioverter-defibrillators.

This paper, prepared for the Health Evidence Network of the World Health Organization, synthesizes the evidence pertaining to what is known about the effectiveness of economic instruments to reduce consumption of foods high in saturated fats and other energy-dense foods for preventing and treating obesity. The review found no direct scientific evidence of a causal relationship between policy-related economic instruments and food consumption, including foods high in saturated fats. Indirect evidence suggests that such a causal relationship is plausible, though it remains to be demonstrated by rigorous studies in community settings. Modeling analyses suggest that a combination of increased prices (in the form of taxes) for such nutrients as fat, saturated fat and sugar and subsidies on fibres could reduce consumption of the taxed nutrients, as well as total energy intake. Studies of tax and price policies applied to tobacco and alcohol products may serve as models for lowering consumption of energy-dense foods, but critical differences among these types of interventions may limit their generalizability to food consumption. The paper also addressed considerations for future policy and research.

The Lewin Group was commissioned by the Dietary Supplement Education Alliance to (1) critically review the research literature for two dietary supplements for which an association has been shown between intake of the supplement and reduced risk of a disease that can lead to a loss of an older person's independence, and (2) develop estimates of potential health care savings that could result from daily use of the supplement. Supplement/disease combinations in this study are omega-3 fatty acids and coronary heart disease, and lutein/zeaxanthin and age-related macular degeneration.